HomeSafe: Postpartum Hypertensive Care Enabled by Electronic Health Record Digital Blood Pressure Capture and Population Health Management

Objective To present stepwise refinements to HomeSafe, an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure surveillance after hypertensive disease of pregnancy (HDP). Study Design HomeSafe was designed for HDP people identified during their delivery hospitalization. The program incorporated pre-populated orders for home blood pressure measurement and submission through a smartphone application linked to the electronic health record (Epic).1 A population health coordinator (PHC) was integrated at Year 2 to support registry tracking, expanded digital support and metric driven reviews. Study data were managed using REDCap (Research Electronic Data Capture); a secure, web-based application hosted by Massachusetts General Brigham Digital Research Applications team.2,3 Year to year analyses were performed for blood pressure submission and route, predictors of timely blood pressure return (≥1 blood pressure in 7 days), six-week postpartum visit attendance, and clinical and demographic variables. Results Across 24 months, 640 postpartum HDP individuals were enrolled; 68.6% (439/640) submitted blood pressure in a timely fashion. In Year 1, 44.9% of BPs submission was by EPIC (44.9%), portal (8.2%) or phone (15.5%). No blood pressure was submitted by 31.4%. With a PHC (year 2), Epic-routed capture increased to 56.5%, and phone/portal-dependent routes decreased to 11.6% (p=0.0006). Program enrollment increased from 245 to 485 (p<0.001) without changes in delivery volume. Independent negative predictors of blood pressure return were Black non-Hispanic race, public insurance, and multiparity; HDP subtype, delivery mode, antihypertensive use, and NICU admission were not predictive. HomeSafe engagement strongly predicted six-week postpartum visit attendance (89.9% vs 65.4%, p<0.0001). Conclusion HomeSafe, an EHR-tethered, postpartum blood pressure surveillance pathway, when partnered with a population health management approach and a coordinator provides significant improvements in blood pressure ascertainment, enrollment scalability, and six-week postpartum engagement. Persistent disparities by race and insurance status highlight a need for equity-focused approaches.